School shooters and mental health. What is Texas actually doing?

The day after a gunman killed 19 fourth graders and two teachers at their Ovaldi elementary school, the father of one of the murdered children was shown on national television clinging to a framed picture of his daughter. Angel Garza said Amerie Jo was killed while trying to call 911 for help.

“How do you look at this girl and shoot her?” He mourned.

Even in a world where corruption is rampant, it is incomprehensible to most of us that someone would point a gun at children and execute them. Politicians searching for answers often turn to mental illness as a way to avoid discussions about gun control. Governor Greg Abbott emphasized at a press conference last week that “Anyone who shoots anyone else is facing a mental health challenge. Period.”

This response undercut what should be a subtle conversation about how Texas defines and treats people who might harm themselves or others, and how we keep guns out of their hands. The blanket comments about the mental health of mass shooters are also harmful to people in this country who suffer from mental illness: 1 in 5 Americans, the majority of whom are not violent.

Secret Service analysis of 41 attacks in K-12 schools between 2008 and 2017 could be useful to Texas lawmakers as they debate measures related to school safety and mental health. The report, published three years ago, found that most school-age attackers like the Yuvaldi gunman share certain traits and conditions.

All of the attackers had a source of social stress at least six months prior to the attacks, such as bullying or disagreements with romantic partners and family members. Almost every attacker had problems at home—their parents’ divorce or relatives’ drug abuse, for example—and most of the attackers also had a history of school discipline.

Psychological, behavioral, and neurological symptoms were graded in the majority of minor attackers. These symptoms ranged from depression to aggressiveness to learning difficulties. But only 40% of perpetrators had a documented mental health diagnosis before the attacks.

“When considering such signs and symptoms, it is possible that underlying situational factors (eg, stressors the child is experiencing) are the cause of the behavior, rather than a diagnosable disorder,” the Secret Service report warns.

Now add weapons to this toxic mix of internal and external factors. Most of the perpetrators had access to firearms and used them in the attacks.

The Uvalde fighter, an 18-year-old man, had no history of a mental health diagnosis, although he acted in disturbing ways before storming Robb Elementary School with a semi-automatic rifle. People who knew him said he abused animals, threatened girls online and once admitted to cutting his face.

It is possible that the shooter had an undetected mental illness. But we cannot assume that all mass murderers have diagnosable clinical conditions. A steady diet of hate ideology can fuel violence, along with antisocial traits like anger and defiance that go to the extreme.

People are complex, and so should the Texas Mental Health System and Behavioral Interventions for Children and Youth. Lawmakers should consider whether schools are appropriately equipped to report on related behaviors and what the state can do to expand mental health screenings and treatment.

The Texas legislature took important steps after the Santa Fe High School shootings in 2018. It passed a law requiring every school to have a behavioral threat assessment team to identify students who could pose threats so they could be referred to mental health professionals or to the police . Lawmakers would be wise to investigate how this procedure works in practice.

The legislature in 2019 also established the Child and Adolescent Mental Health Care Consortium. This consortium launched a telehealth network of medical professionals and consultants from dozens of medical schools, each one responsible for an area in Texas. The consortium offers this telehealth program free of charge to school districts, which can refer children with problems for services.

Nearly a quarter of Texas’ 1,200-plus districts participate in the Access to Texas Children’s Health by Telemedicine Program, or TCHATT, which covers more than two million students. A program official told Texas Tribune That the Ovaldi school district was in line to provide services prior to the shooting but was not officially included due to employment. The consortium plans to request more resources in the upcoming legislative session.

State lawmakers should also consider expanding other programs that research shows have improved outcomes for children and young adults with mental health symptoms.

For example, young adults experiencing their first episode of psychosis — a disorder that causes hallucinations and delusions — can benefit from an intensive care model known as coordinated specialized care, according to the Meadows Institute for Mental Health Policy. A team of specialists works with the person and their family for two or three years to manage a treatment plan that may include medication, therapy, and employment or educational positions.

The earlier the treatment, the better the quality of life. In Texas, this type of sponsorship is largely funded by federal grants. Experts say that many services provided under this model of care are not covered by private insurance, which creates a barrier to accessing them.

Another team-based model of care for teens with significant mental health concerns is called multisystem therapy, and it’s designed to highly involve teens’ families in their treatment. This model has shown good results among juvenile offenders, but mental health advocates say it should be expanded beyond the juvenile system. The goal, after all, is to keep teens out of trouble.

Governor Abbott was right that we need to do something about mental health care in Texas. And we need to do something about easy access to guns. Focusing on the first and ignoring the second will lead to more child deaths in schools where they should be safe.